Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02680 | Date 01/08/2019 |
| Token No | SM/18-19/5320 01/08/2019 | Serial | 011 |
| Patient Name | Mr. RAJ SHARMA | Contact No | 6290122243 |
| Address | 3 WILLIAM CERRY ROAD | Age | 13 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||